II 111th CONGRESS 1st Session S. 1262 IN THE SENATE OF THE UNITED STATES June 15, 2009 Ms. Cantwell introduced the following bill; which was read twice and referred to the Committee on Finance A BILL To amend title VII of the Public Health Service Act and titles XVIII and XIX of the Social Security Act to provide additional resources for primary care services, to create new payment models for services under Medicare, to expand provision of non-institutionally-based long-term services, and for other purposes.

1.

Short title

This Act may be cited as the Medical Efficiency and Delivery Improvement of Care Act (MEDIC) of 2009.

2.

Table of contents

The table of contents for this Act is as follows: Sec. 1. Short title. Sec. 2. Table of contents. TITLE I—Loan Program Provisions Sec. 1001. Short title. Sec. 1002. Hospital residency loan program. TITLE II—Primary Care Provisions Sec. 2001. Short title. Sec. 2002. Findings. Sec. 2003. Definitions. Subtitle A—Medical education Sec. 2101. Recruitment incentives. Sec. 2102. Debt forgiveness, scholarships, and service obligations. Sec. 2103. Deferment of loans during residency and internships. Sec. 2104. Educating medical students about primary care careers. Sec. 2105. Training in family medicine, general internal medicine, general geriatrics, general pediatrics, physician assistant education, general dentistry, and pediatric dentistry. Sec. 2106. Increased funding for National Health Service Corps Scholarship and loan repayment programs. Subtitle B—Medicaid Related Provisions Sec. 2201. Transformation grants to support patient-centered medical homes under Medicaid and CHIP. Subtitle C—Medicare Provisions Part I—Primary Care Sec. 2301. Reforming payment systems under Medicare to support primary care. Sec. 2302. Coverage of patient-centered medical home services. Sec. 2303. Medicare primary care payment equity and access provision. Sec. 2304. Additional incentive payment program for primary care services furnished in health professional shortage areas. Sec. 2305. Permanent extension of Medicare incentive payment program for physician scarcity areas. Sec. 2306. HHS study and report on the process for determining relative value under the Medicare physician fee schedule. Part II—Preventive services Sec. 2311. Eliminating time restriction for initial preventive physical examination. Sec. 2312. Elimination of cost-sharing for preventive benefits under the Medicare program. Sec. 2313. HHS study and report on facilitating the receipt of Medicare preventive services by Medicare beneficiaries. Part III—Other provisions Sec. 2321. HHS study and report on improving the ability of physicians and primary care providers to assist Medicare beneficiaries in obtaining needed prescriptions under Medicare part D. Sec. 2322. HHS study and report on improved patient care through increased caregiver and physician interaction. Sec. 2323. Improved patient care through expanded support for limited English proficiency (LEP) services. Sec. 2324. HHS study and report on use of real-time Medicare claims adjudication. Sec. 2325. Ongoing assessment by MedPAC of the impact of Medicare payments on primary care access and equity. Sec. 2326. Distribution of additional residency positions. Sec. 2327. Counting resident time in outpatient settings. Sec. 2328. Rules for counting resident time for didactic and scholarly activities and other activities. Sec. 2329. Preservation of resident cap positions from closed and acquired hospitals. Sec. 2330. Quality improvement organization assistance for physician practices seeking to be patient-centered medical home practices. Subtitle D—Studies Sec. 2401. Study concerning the designation of primary care as a shortage profession. Sec. 2402. Study concerning the education debt of medical school graduates. Sec. 2403. Study on minority representation in primary care. TITLE III—Medicare Payment Provisions Sec. 3001. Short title. Sec. 3002. Findings. Sec. 3003. Value index under the Medicare physician fee schedule. TITLE IV—Long-Term Services Provisions Sec. 4001. Short title. Subtitle A—Balancing Incentives Sec. 4101. Enhanced FMAP for expanding the provision of non-institutionally-based long-term services and supports. Subtitle B—Strengthening the Medicaid Home and Community-Based State Plan Amendment Option Sec. 4201. Removal of barriers to providing home and community-based services under State plan amendment option for individuals in need. Sec. 4202. Mandatory application of spousal impoverishment protections to recipients of home and community-based services. Sec. 4203. State authority to elect to exclude up to 6 months of average cost of nursing facility services from assets or resources for purposes of eligibility for home and community-based services. Subtitle C—Coordination of Home and Community-Based Waivers Sec. 4301. Streamlined process for combined waivers under subsections (b) and (c) of section 1915. TITLE V—Home and Community-Based Services Provisions Sec. 5001. Short title. Sec. 5002. Long-term services and supports.

.